Anaesthesia
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Neurogenic pulmonary oedema is a not uncommon condition with a mortality that may exceed 90%. A fatal case in a 17-month-old child is reported. The literature is reviewed and current theories of the pathogenesis presented. Suggestions are made on how the condition might best be managed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural versus intramuscular fentanyl. Analgesia and pharmacokinetics in labour.
In a randomised double blind trial, 36 patients in the first stage of labour received either epidural or intramuscular fentanyl at the same time as the epidural test dose of bupivacaine. Analgesia was more rapid in onset and more complete in the epidural fentanyl group. ⋯ Plasma fentanyl concentrations showed wide interindividual variation, but after epidural fentanyl the peak occurred earlier. There was no correlation between analgesia and plasma fentanyl concentration, and epidural fentanyl produced superior analgesia but a systemic contribution to this effect cannot be ruled out.
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Comparative Study
Forum. Femoral neck surgery using a local anaesthetic technique.
Thirty cases of femoral sub-capital fractures, Garden grades 1-4, were reduced and internally fixed with crossed Garden screws using femoral nerve block. In addition, sedation and analgesia was provided by low dose ketamine and diazepam. No deaths or other complications occurred in these patients. In a similar group of patients who received spinal analgesia in the same unit under similar conditions there was one death and two cerebrovascular accidents.
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Comparative Study
Penile block for circumcision? A comparison with caudal blockade.
A prospective blind trial was conducted comparing the analgesia and adverse effects produced by caudal extradural blockade (caudal block) with blockade of the dorsal nerves of the penis (penile block) in 38 boys undergoing elective circumcision. Analgesia was assessed by senior nurses using a linear analogue scale and by the response to direct questioning over the first 7 hours after surgery. ⋯ One technical failure occurred in the penile block group. It is concluded that a penile block is a satisfactory alternative to caudal blockade with regard to postoperative analgesia and offers several specific advantages.
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Phantom limb pain following amputation is a well known but comparatively rare phenomenon. Spinal anaesthesia in amputees may cause reappearance of phantom pain in previously pain-free patients despite complete sensory analgesia. Two such cases are described.